Periodontal Disease InformationPeriodontal Disease and Systemic Disease

About Periodontal Disease

Periodontal disease is a bacterial infection of the gums and bone supporting the teeth.

Periodontal disease can affect one tooth or many teeth. The main cause of periodontal disease is bacterial plaque, a sticky film that constantly forms on the teeth. If plaque is not removed, it turns into a hard substance called calculus in less than two days. Calculus (or tartar) can only be professionally removed.

Plaque is an accumulation of bacteria which can infect the gingival (gum) tissues.

The bacteria and the poisons they release cause the gingival tissues to become inflamed and bleed easily (Gingivitis). If this inflammation is not reversed, it proceeds to affect the bone tissue. As the infection spreads to the deeper tissues, it causes the gingival (the gums) to separate from the teeth, forming pockets that in turn invite further plaque accumulation.

There are many types of periodontal diseases. The following is an overview of the most common.

Gingivitis – As the mildest of the periodontal diseases, gingivitis causes the gums to becomes red, swollen, and bleed easily. There is usually no discomfort at this stage.

Chronic Periodontitis – Chronic periodontitis is a condition resulting in inflammation within the soft tissues surrounding the teeth causing progressive attachment and bone loss. It is diagnosed by bone loss on a dental X-ray, the formation of gum pockets and/or receding gums. It is most common in adults, but can occur at any age.

Aggressive Periodontitis - This form occurs in patients who are otherwise in good health. Common features include rapid attachment loss and bone destruction. There are two forms of aggressive periodontitis:

  • Localized Aggressive Periodontitis – Most often occurs near puberty and usually involves attachment loss around the first molars and/or front teeth but may involve one or two additional teeth.
  • Generalized Aggressive Periondontitis – Usually, but not always affects people under 30 years of age. It involves attachment loss on at least three permanent teeth in addition to first molars and incisors.

Periodontitis as a Manifestation of Systemic Disease- As the name indicates, this form is associated with one of several systemic diseases that are related to periodontitis, such as diabetes.

Necrotizing Periodontal Diseases – These types of periodontal diseases cause ulcers in the gums between the teeth and are most commonly observed in individuals with certain conditions including, but not limited to, HIV infection, malnutrition and immunosuppression. Stress, smoking and poor oral hygiene sometimes can contribute to this problem.

Periodontal diseases are often silent, meaning that symptoms may not materialize until significant bone loss has occurred. Some people may have periodontitis and not experience any symptoms and be unaware that they have disease. Common symptoms and signs of periodontal diseases include:


If you notice any of these symptoms, you should see a periodontist for a complete periodontal examination. A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of tissues surrounding the teeth. In addition, periodontists are trained in the placement and maintenance of dental implants.

Periodontal surgery is performed with local anesthesia. The procedure takes 1 to 1 ½ hours. There is no pain involved during the procedure, as the area is completely numb. Following the procedure, a moderate analgesic such as ibuprofen is all that is required. Most patients return to work either the same day or preferably the next day. If you have any questions, please ask the doctor.

Surgery has been recommended to correct or improve a periodontal problem that is affecting your oral health. The choice of surgical technique depends on the type and severity of the disease and other conditions in your mouth.

You need periodontal surgery because your periodontist has determined that the tissues around your teeth are unhealthy and cannot be repaired with non-surgical treatment.

The following are some of the reasons why surgery might be necessary:

  • To clean and reduce periodontal pockets
  • As you probably have learned by now, the main cause of periodontal disease is plaque, a sticky, colorless film that constantly forms on your teeth. If the plaque is not removed thoroughly, toxins or poisons produced by bacteria in the plaque irritate the gums and destroy supporting tissues around the teeth, forming pockets.

  • To regenerate or regrow tissue
  • Eventually, the plaque hardens into a rough deposit called calculus or tartar. Over time, as more plaque and calculus build up, the gums continue to pull away from the teeth and pockets deepen. Affected teeth can become loose and eventually may be lost.

    You cannot keep deep pockets clean and free of plaque just by brushing and flossing alone. The pockets also may be too deep even for your dentist or hygienist to clean. Therefore, your periodontist may decide that surgery is necessary to remove plaque and calculus below the gumline. Your periodontist will reduce the pockets and position the gums to minimize areas where disease-causing bacteria can hide.

  • To reshape damaged bone
  • If bone loss has occurred, your periodontist might perform osseous (bone) surgery. This is done to smooth the uneven or irregular surface of the damaged bone and promote healing of the periodontal pocket.

    If the disease goes untreated, damage to gum and bone attachment to the teeth will continue. Plaque accumulates along the roots of the teeth, resulting in infection that may cause more serious damage to the bone supporting the teeth.

    Your periodontist may recommend surgical procedures to regenerate bone and supporting tissues previously lost to the disease. These techniques restore and strengthen the support of the teeth so they can function longer. In fact, there are many new technologies available to enhance bone regeneration. You may want to talk with you periodontist about these.

  • To expose more of the tooth to make dental repair possible
  • When a tooth is decayed or broken below the gumline, periodontal surgery might be needed to adjust the gum and bone level to expose more of the tooth so it can be repaired.

  • To improve appearance
  • In certain instances, appearance can be improved with periodontal surgery. For Example, a “toothy” smile caused by gum recession or shrinkage often can be corrected by soft tissue grafting techniques. Soft tissue grafting also helps prevent further gum recession. Likewise, teeth can be made to look longer for a patient with a “gummy” smile. These are just two examples of how periodontal surgery can improve your appearance.

The main cause of periodontal disease is bacteria in the form of a sticky, colorless plaque that constantly forms on your teeth. However, many factors can cause periodontal disease or influence its progression.

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming “pockets” around the teeth.

Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, too much bone is lost, and the teeth need to be extracted.

During this procedure, Dr. Sazlmann folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.

You may have asked your Periodontist about procedures to improve a “gummy” smile because your teeth appear short. Your teeth may actually be the proper length, but they’re covered with too much gum tissue. To correct this, Dr. Salzmann performs crown lengthening.

During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural broad smile.

Dr. Salzmann may also recommend crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone levels to expose more of the tooth so it can be restored.

When recession of the gingival (gums) occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem, gum reconstruction using grafting techniques is an important option. When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost.

For more severe gingival recession, a gingival graft is usually required. At this stage, no matter how meticulously the patient tries to control the bacteria, there is a greater chance of bacteria penetrating and affecting the underlying supporting bone around the tooth. In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance of the gum and tooth. Also, gum recession, when significant, can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries or root decay and root gouging.

During a gingival graft procedure, a thin piece of tissue is taken from the roof of the mouth, or gently moved over from adjacent areas, to provide a stable band of attached gingival (gums) around the tooth. This barrier prevents further recession and infection. This process also eliminates marginal inflammation, which is usually associated with a mucosal marginal gingival tissue. Exposed roots can sometimes be covered by placing a graft directly over the site.

Pocket elimination treatment is the surgical removal of deep periodontal pockets adjacent to the teeth, created by plaque and calculus deposits. The goal of periodontal pocket elimination is to reduce the pockets. This procedure is done with local anesthetics just like a filling or a crown and most people return back to work the next day.

During this procedure, the gum is elevated like a "shingle," the root surface is cleaned and detoxified, and the gum is replaced so as to allow it to reattach. Thus the pocket is eliminated as the clean roots invite the reattachment of the gum tissue.

The jawbone is what supports your teeth and gums. Unfortunately, periodontal disease destroys parts of the jawbone. This causes bone loss and eventual loss of teeth. The first step is to eliminate the periodontal disease, thereby halting the bone loss. Then the bone damage is repaired.

Bone grafting is a surgical procedure in which new bone or a replacement material is placed into spaces between the teeth and the existing bone. Dr. Salzmann administers a local anesthetic and gently opens the area, eliminates the periodontal disease and then finally fills in the damaged area with bone grafting material.

Many insurance plans pay a portion of periodontal services. Your periodontal health is important, so talk to your Periodontist about treatment options. Oftentimes, the office staff will work with your insurance company to secure maximum benefits.

A dental implant is an artificial tooth root placed into the jawbone to hold a replacement tooth or bridge in place. While high-tech in nature, dental implants are actually more conservative than traditional bridgework, since implants do not rely on neighboring teeth for support. Traditional bridgework involves filing down healthy teeth.

Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth.

The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.

Dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Since periodontists are the dental experts who specialize in precisely these areas, they are ideal members of your dental implant team. Not only do Periodontists have experience working with other dental professionals, they also have the special knowledge, training and facilities that you need to have teeth that look and feel just like your own.

If you are missing a single tooth, one implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root.

If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots.

If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them. Dental implants will replace both your lost natural teeth and some of the roots.

Periodontal disease (also known as gum disease) is a bacterial infection that, left untreated may increase in severity. As a diabetic, you are at higher risk for developing these types of infections, which can impair your ability to process and/or utilize insulin. This may cause your diabetes to be more difficult to control and your infection to be more severe than a non-diabetic.

Like Diabetes, periodontal disease can be monitored and controlled. With careful attention to your at-home oral hygiene and regular professional checkups, a periodontal infection should never play a major role in your diabetes.

In addition to periodontal disease, Diabetics are susceptible to a number of oral conditions such as:

Any type of wound usually takes longer to heal in diabetics than in non-diabetics.

Reduction in saliva may lead to an increased amount of plaque and calculus (this, in turn, may increase your chances for developing periodontal disease and cavities). Some medications also can contribute to reduced saliva production.

This is a common complaint among controlled diabetics.

Some studies indicate that sugars in gingival fluid (the fluid in the space between the gum and tooth) can contribute to increased plaque, as well as the development of periodontal disease and cavities.

Conversely, studies show that well-controlled diabetics have a lower incidence of cavities than uncontrolled diabetics or non-diabetics. This is probably a result of a diet low in refined sugars and careful attention to oral health.

Some studies indicate that sugars in gingival fluid (the fluid in the space between the gum and tooth) can contribute to increased plaque, as well as the development of periodontal disease and cavities.

Whether you smoke, dip or chew tobacco, you are more likely to have periodontal disease – and to have it more severely – than those who do not use any form of tobacco. Recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

Smokers – As a smoker, you are more likely than non-smokers to have calculus form on your teeth, have deeper pockets between your teeth and gums, and lose more of the bone and tissue that support your teeth. If the calculus is not removed during a professional cleaning, and it remains below your gumline, the bacteria in the calculus can destroy your gum tissue and cause your gums to pull away from your teeth. When this happens, periodontal pockets form and fill with disease-causing bacteria. If left untreated, periodontal disease will progress. The pockets between your teeth and gums can grow deeper, allowing in more bacteria that destroy tissue and supporting bone. As a result, the gums may shrink away from the teeth making them look longer. Without support, your teeth may become loose, painful and even fall out.

Research shows that smokers lose more teeth than non smokers. Smoking decreases the circulation to the gums and as a result, less oxygen and nutrients are available to keep gums healthy. Less circulation to the gums also means that less white blood cells are available to fight bacteria that cause gum disease.

Smokeless Tobacco Users – As a user of smokeless tobacco, your gums are more likely to recede, and you have a greater chance of losing the bone and fibers that hold your teeth in your mouth. If your gums recede to the point where the tooth roots are exposed, your teeth may become susceptible to root cavities or sensitive to cold and touch (not to mention the fact that your chances of developing oral cancer increase with smokeless tobacco use).

These problems, associated with tobacco use of any kind, are caused by the many chemicals, such as nicotine and tar, in tobacco. These chemicals have harmful effects on the periodontal tissues. They cause an increase in the accumulation of plaque and calculus (or tartar) that can irritate your gums and lead to infection. Following periodontal treatment or any type of oral surgery, the chemicals in tobacco can also slow down the healing process and make the treatment results less predictable.

Researchers also are finding that many of the following problems occur more often in patients who use tobacco:

  • Oral cancer
  • Bad breath
  • Stained teeth
  • Tooth loss
  • Bone loss
  • Loss of taste and smell
  • Less success with periodontal treatment
  • Less success with dental implants
  • Gum recession
  • Mouth Sores

Gums that are free from disease are essential to keeping your teeth for a lifetime.